AB0489 MAJOR ADVERSE CARDIOVASCULAR EVENTS AND MALIGNANCY POST JAK INHIBITORS INITIATION, A 4-YEAR EXPERIENCE FROM QATAR POPULATION
Authors: O. Alsaed, A. Poil, M. Ahmed, S. Al Emadi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In contrast to ORAL Surveillance data, reports from real world data did not show difference in rates of major adverse cardiovascular events (MACE) and malignancy between tofacitinib and biologic disease modifying anti-rheumatic drugs (b-DMARDs) [1-3]. <h3>Objectives</h3> Investigate the rate of MACE and malignancy post janus kinase inhibitors (JAK-i) initiation in Qatar population. <h3>Methods</h3> All JAK-i prescriptions were captured electronically from the database of the pharmacy of Hamad Medical Corporation (HMC) from January 2018 to November 2022. Patients with non-dispensed prescriptions were excluded from the analysis. Electronic medical records of patients who received any class of JAK-i were reviewed retrospectively to identify demographic and clinical characteristics, starting and stopping date of JAK-i, MACE and malignancy events post JAK-i initiation. <h3>Results</h3> 219 JAK-i course therapies (tofacitinib 193, upadacitinib 14 and baricitinib 12) were identified from the database of the pharmacy of HMC. Six patients were excluded from the analysis as they were prescribed with JAK-i but their prescriptions were not dispensed. Five patients received two classes of JAK-i due to treatment failure. Mean (standard deviation [SD]) time of JAK-i exposure was 25 (17) months. A total of 208 patients included in the analysis with mean (SD) age at JAK-i initiation was 45.9 (14) years. Females were 72% of the cohort. JAK-i was prescribed for the following indications: rheumatoid arthritis 129 (60%), psoriatic arthritis 28 (13.1%), alopecia 29 (13.6%), spondyloarthropathy (SPA) 16 (7.5%), inflammatory bowel disease (IBD) 8 (3.8%), other rheumatic diseases 5 (2.3%). Two patients were having IBD with peripheral and axial SPA involvement. In patients with rheumatic diseases, JAK-i was received in 102 (55%) b-DMARDs naïve patients, post one b-DMARDs in 38 (20%) and post ≥ 2 in 46 (25%) patients. The comorbidity profile (hypertension, dyslipidemia, diabetes mellitus, and coronary artery disease) was 27%,25%, 23%, and 5.6%, respectively. New cancer diagnosis (follicular thyroid) was confirmed in one patient post tofacitinib and one patient developed lymphoma relapse after tofacitinib initiation. One ischemic cerebrovascular accident (CVA) identified post tofacitinib initiation. This patient was in atrial fibrillation when CVA occurred. No venous thromboembolism events reported from this cohort. <h3>Conclusion</h3> MACE and malignancy rates are very low in JAK-i users in Qatar population. Comparator group is needed for further evaluation the association of the use of JAK-i and risk of MACE and malignancy. <h3>References</h3> [1]Ytterberg SR, Bhatt DL, Mikuls TR, Koch GG, Fleischmann R, Rivas JL, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-26. [2]Charles-Schoeman C, Buch MH, Dougados M, Bhatt DL, Giles JT, Ytterberg SR, et al. Risk of major adverse cardiovascular events with tofacitinib versus tumour necrosis factor inhibitors in patients with rheumatoid arthritis with or without a history of atherosclerotic cardiovascular disease: a post hoc analysis from ORAL Surveillance. Ann Rheum Dis. 2023;82(1):119-29. [3]Kremer JM, Bingham CO, 3rd, Cappelli LC, Greenberg JD, Madsen AM, Geier J, et al. Postapproval Comparative Safety Study of Tofacitinib and Biological Disease-Modifying Antirheumatic Drugs: 5-Year Results from a United States-Based Rheumatoid Arthritis Registry. ACR Open Rheumatol. 2021;3(3):173-84. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.